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Are mixed germ cell tumors treated as seminoma or nonseminoma?

Nonseminoma

1

What are the risk factors for germ cell tumors?

Abdominal and inguinal cryptorchidism, spermatic or testicular dysgenesis, and family history. Klinefelter syndrome is a risk factor for mediastinal germ cell tumors.

2

T or F: If testicular ultrasound is abnormal, biopsy should be performed.

False. A radical inguinal orchiectomy should be performed. A biopsy is contraindicated because the normal vascular and lymphatic drainage would be disturbed.

3

What are the nonseminoma histologies?

Embryonal carcinoma, teratoma, choriocarcinoma, yolk sac or endodermal-sinus tumors.

4

Does an abnormal serum AFP level indicate a seminoma or nonseminoma?

Always nonseminoma.

5

What are the adverse factors of germ cell tumors?

Mediastinal primary site; degree of elevation of AFP, HCG, LDH; nonpulmonary visceral mets

6

What is the treatment for stage I seminoma?

Radical inguinal orchiectomy. Afterwards, options include: surveillance, radiation to the para-aortic nodes, or a single dose of carboplatin. XRT is contraindicated if IBD or horseshoe kidney.

7

Treatment for stage IIA seminoma?

Radiation.

8

Treatment for stage IIB seminoma?

Chemotherapy or radiation.

9

Treatment for advanced seminoma?

Chemotherapy. After 6 weeks, get PET CT. If pos, consider surgery.

10

Adjuvant treatment for stage I nonseminoma?

Stage IA: close surveillance. High-risk IB (embryonal predominant, lymphatic, vascular, scrotal, spermatic cord invasion): nerve sparing RPLND.

11

Adjuvant treatment for stage II nonseminoma?

First, RPLND. Then, if N1 (pos node 2 cm or > 5 involved nodes or extranodal extension) chemo for 2 cycles. If N3 (node > 5 cm), chemo for 3 or 4 cycles. If serum markers do not normalize, surgery.

12

Treatment for advanced germ cell tumor?

Good risk: cis/etop x 4 or BEP x 3. Intermediate risk: BEP x 4. Poor risk: BEP x 4.

13

Salvage therapy for germ cell tumors?

Vinblastine/ifos/cis, TIP (paclitaxel, ifos, cis), cis/epirubicin. If these fail, consider high-dose chemo with peripheral stem cell rescue.

14

After chemo for germ cell tumors, if we have residual radiographic abnormalities but normal serum tumor markers, what should we do next?

Surgery.

15

Which cancers can a teratomatous component of a nonseminoma transform into?

Rhabdomyosarcoma, adenocarcinoma, primitive neuroectoderm tumor, and leukemia.

16

T or F: bladder cancer is more common in men than women, whites than blacks.

T

17

Risk factors for bladder cancer?

Smoking, occupational exposures, urinary tract diseases, drugs.

18

T staging for bladder?

Ta: noninvasive papillary lesions.
Tis: carcinoma in situ
T1: invades the subepithelial connective tissue
T2: invades muscle
T3: invades perivesical tissue
T4: invades prostate, uterus, vagina, pelvic, abdominal wall

19

Treatment for non-muscle-invasive bladder cancer?

Transurethral resection. Intravesical BCG x 6 weekly doses for T1, Tis, and recurrent or multifocal Ta. Other agents: mitomycin C, gem, doxorubicin, valrubicin.

20

Treatment for muscle-invasive bladder cancer?

Neoadjuvant with cis/gem for certain patients, then radical cystectomy with bilateral pelvic lymphadenectomy. No definitive data on adjuvant chemo. A bladder preservation approach using transurethral resection, radiation, chemo can be considered.

21

Treatment for metastatic bladder cancer?

MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) and cis/gem. Both regimens are similarly efficacious.

22

Risk factors for RCC?

Smoking, obesity, hypertension, acquired cystic kidney disease

23

Treatment for localized RCC?

Nephrectomy. No benefit to adjuvant radiation.

24

What is Stauffer syndrome?

Signs and symptoms of hepatic dysfunction in patients with localized RCC.

25

Is there a role for cytoreductive nephrectomy in metastatic RCC?

Yes. Combined with system therapy, it can prolong OS.

26

Histologies of RCC?

Clear cell, papillary (more favorable than clear cell), chromophobe (indolent), and collecting duct (very aggressive).

27

What is Von Hippel-Lindau disease?

RCC, retinal angiomas, hemangioblastomas of the spinal cord and cerebellum, pheochromocytomas. VHL promotes the ubiquitination and destruction of HIF-alpha.

28

Systemic therapies for metastatic RCC?

Bev > placebo. Bev + IFN > IFN alone. Sunitinib > IFN. Pazopanib > placebo. Pazopanib ~ sunitinib (pazo has better QOL). Sorafenib > placebo. Sorafenib ~ IFN. Temsirolimus > IFN. Everolimus > placebo. Can also consider IFN and IL-2.

29

How many men will develop prostate cancer in the United States?

One in six

30

Results of the Prostate Cancer Prevention Trial (with finasteride)?

Reduction in incidence of prostate cancer but more high-grade cancer. No long term difference in OS.

31

Bone scans are recommended in prostate cancer if one of the following is true:

T1-2 and PSA > 20; Gleason 8; T3-4; or symptoms of bone mets

32

Treatment options for localized prostate cancer?

Low risk: active surveillance, brachytherapy, external beam radiation, radical prostatectomy. High risk: combined modality such as external beam radiation with ADT for 3 years.

33

Strong data to support neoadjuvant or adjuvant ADT with surgery for localized prostate cancer?

No

34

Role of neoadjuvant or adjuvant ADT with external beam radiation for localized prostate cancer?

Beneficial. High risk disease: long term ADT for at least 2 years.

35

Which group of patients with localized prostate cancer can have active surveillance?

Good risk: Gleason

36

What are the main side effects of medical or surgical castration?

Gynecomastia, impotence, loss of libido, weakness, fatigue, hot flashes, loss of muscle mass, changes in personality, anemia, depression, and loss of bone.

37

Does denosumab increase bone mass in men receiving ADT for nonmetatastic prostate cancer?

Yes.

38

For metastatic prostate cancer, is combined therapy of GnRH agonist/antagonist and antiandrogen better than monotherapy?

Modest improvement. Antiandrogen monotherapy is inferior to testosterone-lowering therapy.

39

For androgen-sensitive, metastatic prostate cancer, is early ADT better than delayed?

Yes.

40

Continuous versus intermittent ADT for metastatic prostate cancer?

Sand OS and PFS. Better toxicity with intermittent.

41

Results of ADT vs ADT plus docetaxel for metastatic non-castrate prostate cancer?

Better OS for chemohormonal, especially for high volume disease

42

Efficacy of sipuleucel-T?

Better OS than placebo: 25.8 months vs 21.7. But same time to progression.

43

Chemo for metastatic CRPC?

Docetaxel> mitoxantrone. After progression on docetaxel, cabazitaxel > mitoxantrone.

44

Efficacy of abiraterone in CRPC?

Better than placebo both before and after chemo

45

Data on enzalutamide on CRPC?

Better than placebo both before and after chemo

46

Cabozantinib in CRPC?

Pain relief, clinical, soft tissue and bone scan responses.

47

Radium-223 in CRPC?

Better OS compared to placebo in men with symptomatic bone mets.

48

Treatment for bone mets in CRPC?

Denosumab, zoledronate

49

How to treat malignant adrenal cortical carcinoma?

Surgery for localized disease. Otherwise, mitotane.

50

How many patients receiving trimodality bladder preservation therapy will still need cystectomy?

One third

51

Which treatment for CRPC is associated with a survival benefit: strontium-89, samarium-153, radium-223, denosumab, zolendronic acid?

Radium-223

52

Testicular mass in a man older than 50. Most likely diagnosis?

Lymphoma

53

What is the most commonly mutated gene in clear cell RCC?

VHL

54

What should patients on pazopanib have monitored closely?

LFTs